Insurance Civil Remedies

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Insurer Liable for Mandatory Double Damages for Failure to Reimburse a Medicare Advantage Organization for Medicare Benefits It...

Humana Medical Plan, Inc. v Western Heritage Insurance Company ____ F.3d ____ 2016 WL 4169120 (11th Circuit, August 8, 2016) - The federal Medicare and Medicaid Acts have been called “among the most completely...more

Florida Sinkhole Statute And Recovery Of Attorneys’ Fees Without Bad Faith: Florida Supreme Court Reverses The 5th DCA And...

In Johnson v. Omega Ins. Co., 2016 Fla. LEXIS 2148 (Sept. 29, 2016), the Florida Supreme Court determined that the 5th DCA misapplied and misinterpreted two statutes, the first providing a presumption of correctness to the...more

Arizona Court of Appeals Reverses $1 Million Award of Punitive Damages in Insurance Bad Faith Case for Alleged “Institutional Bad...

In Sobieski v. Am. Standard Ins. Co. of Wisconsin, 2016 WL 5436588 (Ariz.App. Sept. 29, 2016), despite upholding a bad faith judgment for an insurer conducting an unreasonable investigation and denying a claim, the Arizona...more

Illinois Appellate Court Affirms a Declaratory Judgment in Favor of the Insurer Where the Underlying Suit Did Not Allege an...

In Westfield Ins. Co. v. West Van Buren, LLC, the Appellate Court of Illinois, affirmed the trial court’s decision holding that the developer, West Van Buren, LLC (“Van Buren”), was not entitled to defense and indemnification...more

Real Property & Title Insurance Update: Week Ending October 7, 2016

Foreclosure: debtor that agreed to “surrender” property in bankruptcy was required to surrender the property to the bankruptcy trustee and secured creditor, and lost right to defend secured creditor’s foreclosure action...more

Eleventh Circuit Affirms Judgment Notwithstanding the Verdict in UIM Bad Faith Case

On Friday, September 30, 2016, the Eleventh Circuit Court of Appeal affirmed a renewed motion for judgment as a matter of law that had been granted by the Middle District Court of Florida in a uninsured/underinsured motorist...more

Insurance Coverage – Insurance Fraud Prevention Act

The People ex rel. Allstate Insurance Company, et al. v. Daniel H. Dahan, et al. - Court of Appeal, Second District (September 15, 2016) - Under Section 1871.7 of the California Insurance Frauds Prevention Act...more

Insurance Coverage – Cancellation of Policy and Bad Faith

Trent Mills v. AAA Northern California, Nevada & Utah Ins. Exchange - Court of Appeal, Third District (September 20, 2016) - Under Insurance Code § 1861.03(c)(1), an insurer has a statutory right to cancel an...more

How Appraisal Protects Against Texas Insurance Code Abuse

Insurance practice in Texas has become somewhat rote. Typically, a petition is filed against both an insurance company (that is often not based or incorporated in Texas) and a local adjuster. In addition to a breach of...more

UK Supreme Court: Fraud Trumps the Finality of Settlements

In a recent decision that can have equal application in the United States, the UK Supreme Court ruled that fraud trumps the public policy arguments of finality and encouragement of settlements....more

Choice-Of-Law Ruling In Massachusetts Diminishes Coverage For Rhode Island Public Utility

The Appeals Court of Massachusetts recently dealt a blow to policyholders by choosing to apply Massachusetts law to the coverage of environmental contamination in Rhode Island. In OneBeacon America Insurance Company v....more

Massachusetts AG Settles With Insurance Company Over Allegedly Improper Force-Placed Insurance

On September 7, 2016, the Massachusetts Attorney General announced a settlement with an insurance company requiring “refunds for Massachusetts homeowners whose mortgage lenders wrongly force-placed the consumers with [the...more

Insurance – Bad Faith Refusal to Settle

Barickman v. Mercury Casualty Company, et al. - Court of Appeal, Second Appellate District (July 25, 2016) - Where a carrier refuses to accept a settlement demand within policy limits, it risks the chance of being...more

Missouri Federal Court Identifies Roadblocks For An Excess Carriers’ Claim For Attorney Fees Against Primary Carrier

The court’s decision in Axis Specialty Insurance Company v. New Hampshire Insurance Company highlights the scope of recovery available for an excess carrier seeking to recover against a primary carrier. Emboldened by the...more

Arbitration Clause Contained Only In “Side” Agreements To Insurance Policies, Enforced In Dispute Over “Retrospective Premiums”

A U.S. District Court for the Southern District of New York recently enjoined Advanced Micro Devices (AMD), from proceeding with litigation in California against National Union Fire Insurance Company (NUFIC), related to a...more

5 Wishes for Securities Litigation Defense: Early Damages Analysis and Discovery

The fifth of my “5 Wishes for Securities Litigation Defense” (April 30, 2016 post) is to move securities class action damages expert reports and discovery ahead of fact discovery. This simple change would allow the...more

Ohio Court Holds No Coverage for Misrepresentation Claims

In its recent decision in Lakeside Terrace Home Sales, Ltd. v. Arrowood Indem. Co., 2016 U.S. Dist. LEXIS 114828 (N.D. Ohio Aug. 26, 2016), the United States District Court for the Northern District of Ohio, had occasion to...more

Expanding When Liability is “Reasonably Clear”: Massachusetts Court Chips Away at Bad Faith Counterarguments

Earlier this month, a Massachusetts Appellate Court affirmed a trial court’s award of bad faith damages in a case where it found the insurer’s approach to a claim to be “at best inattentive, if not incompetent.” Although the...more

Eleventh Circuit Finds Insurer Liable for Medicare Lien Notwithstanding Insurer's Efforts to Satisfy the Lien in Settlement, also...

In a case with far-reaching implications, the Eleventh Circuit Court of Appeals issued an opinion concluding that the Medicare Secondary Payer Act (MSP) permits a private insurance company/PART C Medicare Advantage...more

11th Circuit Awards Humana Double Damages Under Medicare Secondary Payer Act

Humana Medical Plan, Inc. v. Western Heritage Insurance Co., case number 15-11436. Liability insurers beware, as the 11th Circuit held that Medicare Advantage Organizations (MAO) are entitled to the same rights...more

New Jersey Supreme Court Affirms General Contractor’s Insurance Coverage for Consequential Damages Caused by a Subcontractor’s...

In an important recent decision, New Jersey joined a growing number of states holding that Insurance Services Office’s (ISO) 1986 comprehensive general liability (CGL) policy extends coverage to a property developer faced...more

Eleventh Circuit affirms ruling of no coverage based on insured’s failure to cooperate

As a condition to coverage under standard liability policies, the insured is required to cooperate with its insurer. The provision, termed the “cooperation clause,” typically requires the insured to assist with and...more

STOLI Policies Cancelled, Insurers Retain Premium

Two federal appellate courts have affirmed, on different grounds, the cancellation of large life insurance policies that were alleged to be stranger originated life insurance (STOLI), permitting the issuing insurers to retain...more

Health Plan Case Managers Entitled to Overtime Pay

Managed care companies help insurers and government programs coordinate healthcare plans by making coverage determinations for participants. In many situations, case managers conduct utilization reviews to determine the...more

Settling Defendants Beware: Eleventh Circuit Holds Settling Insurer Liable for Failure to Protect Medicare Payments Made by...

Congress created an uproar among personal injury tort defendants and their insurers when it passed the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) less than 10 years ago. The $1,000 per day fine for failure to...more

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